Project Stabilization Agreement (PSA) Contractor Core Workforce Form

Contractor Information Requesting Contractor: Phone: Fax:

Job Site Information Project Name and Number: Address: Job Superintendent: Work Request Start Date and Time: Estimated Work Duration:

Union Registration Employee Classification Contractors Workforce Information Indicate Level Craft/Classification Name and Zip Code of Applicant

Journeyman

Apprentice

UNION USE ONLY Dispatch Information Applicant’s Information Reviewed By:

Date of Union Registration (Referral): UNION DISPATCHER: PLEASE CIRCLE THE ZIP CODE OF THE DISPATCHED WORKER Targete d ZIP 92101 92102 92104 92105 92111 92113 92114 92115 92116 92117 92139 codes SDUSD 91941 91942 91945 91977 92037 92103 92106 92107 92108 92109 92110 92119 92120 ZIP 92121 92122 92123 92124 92126 92129 92131 92133 92134 92136 92140 92145 codes 91901 91902 91903 91905 91906 91909 91910 91911 91912 91913 91914 91915 91916 91917 91921 91931 91932 91933 91934 91935 91943 91944 91946 91948 91950 91951 91962 91963 91976 91978 91979 91980 91990 92003 92004 92007 92008 92009 92013 92014 92018 92019 92020 92021 92024 92025 92026 92027 92028 92029 92030 92036 SD 92040 92054 92055 92056 92057 92058 92059 92060 92065 92066 92067 92069 92070 County 92071 92075 92078 92079 92082 92083 92084 92086 92090 92091 92092 92093 92096 ZIP codes 92112 92118 92125 92127 92128 92130 92132 92135 92137 92138 92141 92142 92143 92144 92147 92149 92150 92152 92153 92154 92155 92158 92159 92160 92161 92162 92163 92164 92165 92166 92167 92168 92169 92170 92172 92173 92174 92175 92176 92177 92178 92179 92182 92184 92186 92187 92190 92191 92192 92193 92194 92195 92196 92197 92198 92199 92081 92672 92536 92061 92563 92259

Targeted ZIP codes: 35% of contractor’s total workforce by craft SDUSD ZIP codes: 70% of contractor’s total workforce by craft SD County ZIP codes: 100% of contractor’s total workforce by craft Note to Dispatching Agent: Please fax a copy of the form to the PSA Coordination Team at fax 858.496.1953